Western University - Survey - Volunteer Interest Form

Inspiring all alumni to share a lifelong commitment, pride and passion for Western. Get involved in Western's Alumni Association.

Stay connected by becoming an alumni volunteer. Choose up to three areas of interest by completing this volunteer interest form.

*1.

Question - Required - First Name:

*2.

Question - Required - Last Name:

*3.

Question - Required - Preferred Email Address:

*4.

Question - Required - Street Address 1:

5.

Question - Not Required - Street Address 2:

*6.

Question - Required - City:

*7.

Question - Required - Province/State:

*8.

Question - Required - Postal/Zip Code:

*9.

Question - Required - Phone Number:

10.

Question - Not Required - Mobile Phone:

*11.

Question - Required - Please check 3 areas that interest you:
Please make between 1 and 3 selections from the choices below.

	Join/start an alumni branch, club or chapter
	Serve on an Alumni Association committee
	Volunteer at an alumni event
	Volunteer as a reunion class leader
	Volunteer as a Backpack 2 Briefcase alumni networker
	Volunteer on a teaching awards selection committee
	Become a Hometown Volunteer for Off to Western
	Provide career related mentoring to a student
	Share your story
	Participate in the Last Lecture planning committee
	Speak at a student or alumni event
	Join the Homecoming Committee